Developmental Status of Five-Year-old Children with Very-Low-Birth-Weight

Objective Some previous studies have reported the improved survival of very-low-birth-weight (VLBW) neonates with no disabilities. However, 16% of these neonates have developmental disorders. Considering the lack of research on the developmental status of five-year-old VLBW children and the importance of early detection and treatment, in this study, we aimed to assess the developmental status of five-year-old VLBW children. Materials & Methods This historical cohort study was conducted on five-year-old children. The participants were divided into VLBW and normal-birth-weight (NBW) groups. Data were gathered using the Ages and Stages Questionnaire (ASQ). This questionnaire consisted of five developmental domains, including communication, gross motor, fine motor, problem-solving, and personal/social skills. Data were reported by measuring descriptive statistics, including mean, standard deviation, number, and percentage, and analyzed by Mann-Whitney U test and independent t-test in SPSS version 22. Results A total of 106 five-year-old children, including two groups of VLBW and NBW, participated in this study. The results of Mann-Whitney U test showed a significant difference between the groups regarding the scores of communication (P=0.002), gross motor (P<0.001), fine motor (P<0.001), and problem-solving (P<0.001) skills. However, no significant difference was found between the groups regarding the personal/social developmental status (P=0.559). Conclusion According to the results, a higher risk of developmental delay was observed in VLBW infants as compared to NBW neonates; therefore, it is recommended to perform developmental screening tests for timely detection of high-risk children and early diagnostic and therapeutic interventions.


Introduction
Very low birth weight (VLBW) is defined as the first neonatal birth weight less than 1500 g. Although today, the mortality rate of VLBW neonates has decreased significantly following the development of intensive care medicine, multiple complications still occur. Cerebral palsy is the most common neurological complication of VLBW neonates (1). Besides, cognitive disorder, blindness, deafness, memory dysfunction, strabismus, speech delay, dyslexia, and behavioral disorders can be mentioned as other significant complications (2).
There are major concerns about the increased survival rate of VLBW neonates, which can increase the rate of neurological disabilities (3). Although some previous studies have reported the improved survival of these neonates with no disabilities (4), 16% of them show developmental disorders (5).
In other words, behavioral and developmental disorders are the most common problems during childhood. However, if diagnostic and therapeutic interventions are applied in preschool years, many problems can be resolved.  (7). Besides, there is a significant relationship between the parents and trained personnel's estimations of child development (8).
The ASQ is a test for assessing 4-to 60-monthold children, with 75% and 100% sensitivity and 95% and 90% specificity in high-risk and normal populations, respectively (9). The validity of this

Materials & Methods
This historical cohort study was conducted on five-year-old children. The participants were divided into VLBW (<1500 g) and NBW groups (>2500 g). Ethical approval was obtained from The "yes", "sometimes", and "not yet" answers were assigned 10, 5, and 0 scores, respectively. If the score was ≥-1 standard deviation (SD) of the cutoff point, the child had no problems, while if it was ≤-2 SD of the cutoff point, he/she needed further assessment. A score between -1 SD and -2 SD of the cutoff point indicated the need for further practice of the skill; assessment was also essential two weeks later. If after two weeks, the score was not ≥-1 SD, further assessment was needed (suspected case).
Data were reported by measuring descriptive statistics, including mean, SD, number, and percentage, and analyzed by Mann-Whitney U test and independent t-test in SPSS version 22. The odds ratio and relative risk were also assessed in this study. P-value <0.05 was considered statistically significant, and a 95% confidence interval was used.

Results
In this study, 106 five-year-old children were examined, including two groups of VLBW   In this regard, a study by Karimi  In another study, the results showed that prematurity and history of VLBW were significantly related to motor disabilities in seven-year-old children (12).

Acknowledgment
This study was financially supported by the Vice Chancellor for Research of Guilan University of Medical Sciences and was extracted from the thesis of the third author (Dr. Narges Akrami).

Authorʼs contribution
Sharafi, R. conceptualized and designed the study, coordinated and supervised data collection, drafted the initial manuscript, and reviewed and revised the manuscript. Hassanzadeh Rad, A. conceptualized and designed the study, coordinated and supervised data collection, drafted the initial manuscript, and reviewed and revised the manuscript. Akrami N. conceptualized and designed the study, coordinated and supervised data collection, drafted the initial manuscript, and reviewed and revised the manuscript. Aminzadeh A. conceptualized and designed the study, coordinated and supervised data collection, drafted the initial manuscript, and reviewed and revised the manuscript. All authors agreed to be accountable for all aspects of the work in ensuring that questions related to the accuracy or integrity of any part of the work are appropriately investigated and resolved.